Basic Information
| Provider Information | |||||||||
| NPI: | 1205815388 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CONNER | ||||||||
| FirstName: | ANGELA | ||||||||
| MiddleName: | MELANIE | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | CNM | ||||||||
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| Mailing Information | |||||||||
| Address1: | 180 SEQUOIA TRCE | ||||||||
| Address2: | |||||||||
| City: | CLEVELAND | ||||||||
| State: | GA | ||||||||
| PostalCode: | 305286585 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7068651367 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3495 PIEDMONT RD NE | ||||||||
| Address2: | NINE PIEDMONT CENTER | ||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303051773 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4043647000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/17/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367A00000X | 128017 | GA | Y | Physician Assistants & Advanced Practice Nursing Providers | Advanced Practice Midwife |
ID Information
| ID | Type | State | Issuer | Description | 00866863A | 05 | GA | MEDICAID |